Much of the discussion and research on opioid-sparing postoperative pain management has centered on orthopedics and spine procedures, where opioid prescriptions have in many cases been successfully reduced or even eliminated in favor of nerve blocks and multimodal pain relief strategies. Now a major Canadian research project has examined the effect of nerve blocks on opioid use after cardiac surgeries.
A multicenter, double-blind, randomized clinical trial led by Unity Health Toronto St. Michael’s Hospital researchers found that the administration of targeted nerve blocks significantly reduced opioid use after open-heart cardiac surgery. The study was published in The Lancet Regional Health – Americas.
The trial, EPOCH-CardioLink-10, was conducted at hospitals across four Canadian provinces. It involved 318 adult patients undergoing median sternotomy, a procedure in which the breastbone is split and then wired closed to heal, between 2023 and 2025. Participants were randomly assigned to two groups: one receiving continuous bilateral superficial parasternal intercostal plane (SPIP) blocks delivering the local anesthetic ropivacaine for two days postoperatively, the other receiving a placebo for the same length of time.
“Contemporary international guidelines prioritize opioid-sparing, multimodal strategies; however, robust randomized evidence to support specific opioid-sparing analgesic approaches in cardiac surgery is lacking,” write the researchers, who state that their findings “suggest that bilateral SPIP blockade with ropivacaine may be a pragmatic option to manage sternotomy pain with lower opioid consumption post-cardiac surgery… These findings address a critical evidence gap at the intersection of cardiac surgery and the international opioid crisis. Continuous SPIP blockade reduces opioid exposure without trade-offs and is readily implementable… SPIP blockade should be incorporated into routine perioperative care for cardiac surgery and embedded within international guideline recommendations. Failure to adopt proven opioid-sparing strategies in this setting risks perpetuating avoidable harm at scale.”
Read Unity Health Toronto’s informative article about the study here, and access the full study here.
